4 How to Diagnose it?

Transcript

In the last module, we have seen what all the Clinical pictures of different types of Peritonitis are and what are all the different types of Pericarditis. What is all the clinical pictures animal develops, all those things we have seen in the last module.

In this module How to Diagnose Traumatic Reticulo-peritonitis and Pericarditis, what are all the multimodal approaches various ways we have to diagnose, these cases we will see in this module.

So, as I told in the last module itself, whenever the animal is having Bruxism or Grunting so that animal is suspected of Traumatic Reticulo-peritonitis and Pericarditis, so that is the foremost Clinical sign when any clinician has to suspect the animal is having Traumatic Reticulo-peritonitis and Pericarditis. So apart from that, there are pen site tests that mean which can be done in the field itself. So, the Slope test, Wither pinch test, Pole test, and so on. We will see one by one, what are all those tests:

(Showing video in the slide) This is the Slope test: In the slope, test an animal is made to walk on the slope in an up and down direction. When the animal walks in an up and down direction there will be a grunting sound, see when the animal goes down if the intra-abdominal organs push the thorax the presence of foreign material creates intra-thoracic pain and grunting sound in animals. so generally, in the Slope test when the animal walks downstairs or in the upstairs, there will be a grunting sound. so, this indicates that there is Traumatic Reticulo-peritonitis.

(Showing video in the slide) and if you see this so this animal is examined with a Pole test: so, with the wooden pole, we have to push the ventral thorax at the level of the point of the elbow, then we have to push it upwards when there are intra-abdominal foreign bodies the animal reveals the pain.

(Showing video in the slide) and if you see this is Wither pinch test: if there is any foreign material, the animal exhibits pain so that is Wither pinch test.

So apart from the Pole test, Slope test, Wither pinch test, there are some more Ancillary tests that can be Diagnosed through nearby laboratories or in the laboratory which is available in your locality.

See here if you see any Traumatic Reticulo-peritonitis and Pericarditis, definitely, there will be an increase in the Leukocyte count, and most probably these animals all majority of the times they have Neutrophilia this is number one.

number two this increase in the Leukocyte count depends upon whether the animal is having Acute local peritonitis or Diffuse local diffuse peritonitis. If the animal is having Acute local peritonitis, there will be a Regenerative left shift.

If the animal is having Diffuse peritonitis, there will be a Degenerative left shift will be there. and in Chronic cases majority of the time, there will be a persistent leukocytosis with neutrophilia is the indication that the animal is having Chronic peritonitis.

Apart from the leukogram, there are some other indications, particularly there will be an increase in the fibrinogen level in the blood, which again indicates that the animal is having Traumatic Reticulo-peritonitis, so if you see the level of the acute-phase proteins, particularly serum amyloid-A (SAA), Haptoglobin (Hp) and all other serum acute-phase proteins levels will be elevated. There are some more cardiac biomarkers, particularly Cardiac troponin-I and Cardiac troponin-T both elevated in Traumatic Reticulo-peritonitis and Pericarditis cases. These are all the commercial kits available in the market for the estimation of Fibrinogen and Cardiac troponin.

The next one is Abdominocentesis: generally, Abdominocentesis is carried out in four places; so, four places so abdominal synthesis once you collect the fluid so it indicates that there will be an increase in the protein levels, particularly the protein in the abdomen peritoneal fluid will be more than 3 gram per deciliter, this is one of the indications that the animal is having Peritonitis.

Then there will be an increase in the nucleated cells will be more than 6000 cells per microliter, if the level is so high that indicates again that the animal is having Peritonitis. so this clearly indicates that there is some ongoing pathology is there in the Peritoneum because of the Peritonitis.

Then sometimes rarely, we may not get adequate fluid in Abdominocentesis, but that doesn’t mean that the animal is not having peritonitis. so even failure to get peritoneal fluid also, it won’t exclude that the animal is not having peritonitis.

(Showing video in the slide) For the collection of peritonitis, you see this video the peritoneal fluid collection and we can very easily diagnose the peritonitis through the collection of peritoneal fluid. Once you collect the peritoneal fluid if the fibrinogen level is so high and the material is so purulent, then we can be very easily diagnosed by seeing the appearance one thing and another thing you can smell it sometimes there will be foul-smelling.

(Showing pictures in the slide) And once you collect the fluid, it depends upon the quantum of the fibrinogen level, if the fibrinogen level is so high there will be cake formation immediately so so you see this picture, there will be a fibro purulent material, so there will be in cake formation immediately and if you smell it will be foul-smelling. so that means some purulent material is accumulated in the peritoneum.

Then Pericardiocentesis; at the level of the third and fourth intercostal space that prior to that you have to auscultate and identify the maximum intensity of the heart. Once you identify the maximal intensity, then you can locate it and most probably you can identify the fourth and fifth intercostal space. If particularly on the left side, so left fourth and fifth intercostal space is the right place to do the Pericardiocentesis, so say if you insert the needle and if you touch the myocardium if you attach it with ECG, sometimes there will be an Arrhythmia, if you touch the myocardial tissue then there will be an Arrhythmia.

So, if you are not touching the myocardial tissue, then there won’t be any Arrhythmia and very easily if there is an Effusive Pericarditis or Fibronous Pericarditis, both the things you can get fluid.

(Showing video in the slide) So you see this video just pull the limbs, forelimbs, cranially as much as possible then locate the maximal intensity of the heart and directly you can identify the place, right place, and you can insert the needle.

Once you insert the needle there will be a pericardial fluid will come out and you can collect it and send it to the laboratory.

And the next one is Metal detection: so Metal detectors very easily, we can identify the foreign materials it is a non-invasive technique and very cheap also and the only lacuna with metal detectors are, so we cannot identify, we cannot differentiate the whether the foreign material is penetrating one or nonpenetrating one.

We are using Ferroscopy and this is the ferroscopy most commonly used in animals to identify the foreign materials, particularly for Traumatic Reticulo-pertinotis so and this is the screening of the ferroscopy over the reticular area. Whatever the foreign material is there particularly penetrating foreign bodies, that can be easily identified by the Ferroscopy.

And the next technique is Radiography, it is done in the cranial abdomen to identify the penetrating foreign bodies, metallic foreign bodies. And here the metallic foreign bodies which are more than one centimeter in length and that lie around 30 degrees that lie over the floor that is 30 degrees the floor where it can be diagnosed easily by the Radiography. By radiography, we cannot differentiate the peri-reticular and the hepatic abscesses, that is the only difficulty is the only lack of Radiography.

(Showing pictures in the slide) This is the position of the cassette, where we have to keep the cassettes while taking radiography and this is the metallic foreign body see you can see this arrow-headed point, this point of the arrowhead can be easily revealed in the Radiography. So, the next technique is Ultrasound: by using Ultrasound we can easily diagnose the anechoic areas particularly, the fluid accumulations over the Pericardium, Peritoneum, and Pleural fluids. So, all these things wherever the fluid is there, we can easily be diagnosed by the anechoic fluid accumulation.

Then not only the fluid accumulation so we can identify the gap between the reticulum and the abdominal wall. The other things are so we can easily identify the Perireticular abscess Perireticular adhesions, particularly the reticulo-rumen motility, why the reticulo-rumen motility is decreased, there are effusions particularly because of the Pericardial thoracic or Pleural effusions are there. This can be very easily diagnosed by using Ultrasound.

(Showing video in the slide) If you see this video there is an intestine and outside the intestine, fibrinous material is floating, if you see this video there is fibrinous material along with the pericardial effusion.

And next one is the Postmortem examination: In the postmaster examination, we can easily identify the extensive adhesions number one.

Number two multiple abscesses, and see if there is severe Diffuse peritonitis, there will be a foul-smelling material, particularly there will be a huge quantum of Peritoneal fluid in the Peritoneum and this can be easily diagnosed in the Postmortem Diagnosis and sometimes you may get puss between the layers of the pericardial tissues, so that can also be diagnosed by using postmortem.

(Showing pictures in the slide) So this is the picture you can see the Fibro purulent material, which is a deposit, this is because of Traumatic Reticulo-pericarditis.

So, in this module we have seen different modes of how to Diagnose the Traumatic Reticulo[1]peritonitis and Pericarditis, particularly we have seen the pen site tests and then we have Ancillary tests and then Pericardiocentesis and Abdominocentesis, Radiography and Ultrasonography, and finally the Postmortem examination.

Thank you!